12-month incidence, prevalence, persistence, and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland.

Background: To estimate the 12-month incidence, prevalence, and persistence of mental disorders among recently admitted assisted living (AL) residents and to describe the recognition and treatment of these disorders.

Methods: Two hundred recently admitted AL residents in 21 randomly selected AL facilities in Maryland received comprehensive physician-based cognitive and neuropsychiatric evaluations at baseline and 12 months later. An expert consensus panel adjudicated psychiatric diagnoses (using DSM-IV-TR criteria) and completeness of workup and treatment.

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study.

We compared data drawn from a random sample of 399 current assisted living (AL) residents and a subsample of 222 newly admitted residents for two groups: childless AL residents and AL residents with children. The percentage of childless AL residents (26%) in our study was slightly higher than US population estimates of childless persons age 65 and over (20%). In the overall sample, the two groups differed significantly by age, race and women's years of education.

Correlates of functional dependence among recently admitted assisted living residents with and without dementia.

Objectives: To describe and contrast functional dependency (FD) levels among recently admitted AL residents with and without dementia and to assess the differential contribution of cognitive, behavioral, medical, and social factors on FD within each group.

Design: A cross-sectional study.

Setting: A random sample of 28 AL facilities in the Central Maryland region.

Surrogate decision makers' understanding of dementia patients' prior wishes for end-of-life care.

Objective: This study examines how surrogate decision makers for dementia patients developed an understanding of patient preferences about end-of-life (EOL) care and patient wishes.

Methods: Semistructured interviews were conducted with 34 surrogate decision makers for hospice-eligible nursing home patients with dementia. The data were content analyzed.

The spectrum of medical illness and medication use among residents of assisted living facilities in central Maryland.

Background: Although increasing numbers of older adults are living in assisted living facilities, there is little information on the types and amount of chronic medical illness and the medications required by such residents. To better inform efforts to optimize care in this setting, we sought to quantify chronic medical illnesses and their treatment.

Methods: Medical diagnoses and treatments were derived from chart reviews and interviews of 198 residents of 22 randomly selected assisted living facilities (AL) in central Maryland.

Improper sexual behaviors in elders with dementia living in residential care.

Objectives: There exists little information describing the spectrum and correlations of sexual behaviors manifested by elders with dementia living in residential care.

Methods: Data are from a retrospective case-control study of improper sexual behaviors manifested by 165 elders with dementia living in a residential care facility in 2005.

Results: Three types of behavior were evident: (1) intimacy-seeking, (2) disinhibited, and (3) nonsexual.

Anxiety symptoms among assisted living residents: implications of the "no difference" finding for participants with and without dementia.

Anxiety is a distressing experience at any age but may be particularly disabling when coupled with dementia. Dementia-related anxiety is associated with a range of additional problems among community-dwelling older adults, but little is known about its occurrence in assisted living environments. The purpose of this article is to describe the prevalence of anxiety symptoms among older adults who participated in Phase I of the Maryland Assisted Living Study, a cross-sectional study of 198 participants who underwent comprehensive dementia evaluations.

The association between activity participation and time to discharge in the assisted living setting.

Objectives: Given recent evidence that activity participation may reduce functional decline, the effect of activity on resident ability to remain in assisted living (AL) is of interest. This study examines the relationship between participation in activities and the length of time residents remain in AL.

Methods: The data reported here were gathered in the initial phase of the Maryland Assisted Living Study (MDAL), an epidemiologic study of psychiatric disorders in AL.

Medication use in nursing home residents with advanced dementia.

Objective: To describe medication usage in nursing home residents with advanced dementia, to identify how this usage changed as patients advanced towards death, and to identify correlates of increased medication usage.

Methods: Prospective cohort study (CareAD) during which data on medication prescription were extracted from medical records at regular intervals using standardized extraction procedures.

Results: Patients (n=125) were prescribed a mean of 14.

Acetylcholinesterase inhibitors in assisted living: patterns of use and association with retention.

Objectives: To describe patterns of Acetylcholinesterase inhibitor (ACI) use in an Assisted Living (AL) population, and the association of ACIs with retention in AL.

Methods: As part of the Maryland Assisted Living Study (MD-AL), 198 residents of 22 ALs were evaluated. Dementia was diagnosed in 134, and specifically Alzheimer's disease (AD) in 79, by an expert consensus panel.

Insomnia and daytime sleepiness in people with dementia residing in assisted living: findings from the Maryland Assisted Living Study.

Objective: To estimate the frequency and correlates of insomnia and daytime sleepiness among people with dementia in AL facilities.

Methods: Participants were randomly selected from 22 different assisted living facilities in Maryland. A total of 124 dementia participants were included in the analysis.

Effect of dementia and treatment of dementia on time to discharge from assisted living facilities: the Maryland assisted living study.

Objectives: To estimate the association between dementia and time to discharge from individual assisted living (AL) facilities and examine, in residents with dementia, factors associated with shorter duration of residence in individual AL facilities.

Design: Prospective cohort study.

Setting: Twenty-two AL facilities in central Maryland.

Health problems and correlates of pain in nursing home residents with advanced dementia.

This study describes the health problems and comorbid illnesses of nursing home (NH) residents with advanced dementia (n=123) and identifies correlates of staff-identified pain. Study participants were residents of 3 NHs in Maryland, their surrogate decision makers and their physicians. Residents' cognitive function was assessed at study enrollment, and their medical records were reviewed to identify all health problems/illnesses and use of pain medications during the 6 months before their enrollment.

A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living Study.

Objectives: To compare the demographic, clinical, and psychiatric characteristics of residents living in small (< or = 15 beds) and large assisted living (AL) facilities in the United States.

Methods: One hundred and ninety-eight residents in 10 large and 12 small assisted living facilities were comprehensively assessed as part of the Maryland Assisted Living Study (MD-AL). The presence or absence of dementia and psychiatric disturbances and the facilities' recognition and management of these disorders were compared across the two types of AL.

Depression in assisted living is common and related to physical burden.

Objective: The objective of this study was to obtain a direct estimate of the prevalence of depression, its associated factors, and rates of treatment among residents of assisted living (AL) facilities in central Maryland.

Method: One hundred ninety-six AL residents were recruited from 22 (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. Chart review, staff and family history, comprehensive in-person resident evaluation, and the Cornell Scale for Depression in Dementia (CSDD) were administered by an experienced team of geriatric psychiatry clinicians.

Correlates of caregiver-rated quality of life in assisted living: the Maryland Assisted Living study.

We used a cross-sectional study to examine the correlates of caregiver-rated quality of life (QOL) in 198 randomly selected residents from a stratified random sample of 22 assisted living facilities in central Maryland. We measured QOL by using the Alzheimer's Disease-Related Quality of Life Questionnaire. In general, despite cognitive impairment, residents in assisted living were rated as having a high QOL.

Comparison of three rating scales as outcome measures for treatment trials of depression in Alzheimer disease: findings from DIADS.

Context: Major depression affects about 25% of patients with Alzheimer's disease (AD) and has serious adverse consequences for patients as well as caregivers. Studies of treatments for depression in AD, like most treatment studies, depend on the ability of the scales used to measure outcome to detect a difference between the effects of treatment and control, particularly in trials conducted over waves.

Objective: To compare the ability of three depression scales, and some of their subscales, to detect the difference in the effects of drug (treatment) and placebo (control).

Transition to nursing home from assisted living is not associated with dementia or dementia-related problem behaviors.

Objectives: To examine risk factors for transition from assisted living (AL) care to skilled nursing facility (SNF) care in a random sample of adults residing in AL.

Design: Baseline clinical evaluation and telephone follow-up at 6-month intervals for up to 36 months.

Setting: AL facilities in central Maryland.

The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia.

Purpose: We conducted this study to determine whether neuropsychiatric symptoms and environmental characteristics are associated with quality of life in assisted living residents with dementia.

Design And Methods: We used a cross-sectional study of 134 residents from 22 facilities and employed the Alzheimer's Disease-Related Quality of Life Scale and the Neuropsychiatric Inventory. A scale was developed to capture the homelike climate of each facility.

Sleep disturbances in the elderly residing in assisted living: findings from the Maryland Assisted Living Study.

Introduction: A majority of the elderly suffer from some sort of sleep disturbance. Common sleep disturbances are insomnia and excessive daytime sleepiness. There are no published studies on the prevalence of sleep disturbance in the assisted living (AL) setting.

Predictors of functional impairment in residents of assisted-living facilities: the Maryland Assisted Living study.

Background: Assisted living is a popular residential option for older individuals, yet little research has been done on people choosing this option. This study examines predictors of functional impairment in assisted living residents in the domains of cognition, mood, and health.

Methods: An experienced team of neuropsychiatrists, nurses, and technicians using a number of cognitive, behavioral, health, and functional status tests and a cross-sectional study design assessed 198 residents of 22 assisted living facilities in Maryland.

A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care.

Background: Apathy is a common symptom in patients with dementia and has adverse consequences for patients and caregivers. Most treatments for apathy, particularly non-pharmacologic interventions, have not been evaluated in controlled trials.

Objectives: This study evaluated the efficacy of a kit-based activity intervention, compared to a time and attention control (one-on-one meetings with an activity therapist) in reducing apathy and improving quality of life in 37 patients with dementia.

The Maryland Assisted Living Study: prevalence, recognition, and treatment of dementia and other psychiatric disorders in the assisted living population of central Maryland.

Objectives: To obtain a direct estimate of the prevalence of dementia and other psychiatric disorders in residents of assisted living (AL) in Central Maryland, and their rates of recognition and treatment.

Design: Comprehensive review of history and cognitive and neuropsychiatric evaluations using widely accepted instruments in a randomized cohort of AL residents, stratified by facility size. An expert multidisciplinary consensus panel determined diagnoses and appropriateness of treatment.

Falls and age in patients with Alzheimer's disease.

The study's objective was to estimate the prevalence of falls in community-residing patients with Alzheimer's disease (AD) and to investigate the relationship between falls and age in AD. This was a study of 326 community-residing patients with AD according to National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria. The patients and their caregivers were asked about falls, behavioral disturbances, and medication use within the last 2 weeks.